*Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, West not allowed, United Kingdom; and †Department of Ophthalmology & Visual Sciences, University of Adelaide, South Australian Institute of Ophthalmology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia.

Abstract

Chronic eyelid lymphedema following neck dissection and radiotherapy is rare with 1 report in the literature. The authors report 3 cases and review the literature. Two cases had bilateral neck dissection and developed bilateral eyelid lymphedema and 1 case had unilateral neck dissection (left side) and developed ipsilateral lymphedema. Two patients underwent surgical debulking of lymphedema with significant improvement in symptoms. One patient declined surgical intervention, and the lymphedema remained unchanged. Chronic eyelid lymphedema following neck dissection and radiotherapy occurs where predominant lymphatic drainage to the submandibular and deep cervical lymph node basin is removed. Lymphedema tends to persist when it occurs and in selected cases appearance can be effectively improved by debulking and excision of festoons.

RESULTS:Chronic eyelid lymphedema was associated with acne rosacea in 9 patients, radiotherapy in 1 patient, trauma in 1 patient and post-vitrectomy silicone oil leak in 1 patient. In the remaining 4 patients no associated condition or factor was identified. Surgical debulking was performed in 9 cases with improvement in all cases and no complications.

CONCLUSION:Chronic eyelid lymphedema is a rare condition most commonly associated with rosacea. In our experience, surgical resection of involved subcutaneous tissue was helpful.

Institute of Dermatological Sciences of the University of Milan and IRCCS Ospedale Maggiore of Milan, Milan, Italy.

Abstract

We describe a male patient with rosacea who had a 2-year history of persistent bilateral oedema of the eyelids, leading to an elephantoid condition with blepharoptosis. An upper eyelid blepharoplasty was performed, but swelling progressively recurred over a few months. Based on the case history, clinical appearance and histological findings, rosaceous lymphoedema was considered to be the diagnosis. The latter is a bilateral, solid oedema of the mid-third of the face, regarded as a rare complication of rosacea. It is thought to occur as a result of chronic inflammation and lymphatic stasis, but its exact aethiopathogenesis remains elusive. Predominant eyelid involvement, causing severe visual impairment as in our patient, is unique.